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The Adoption of Preventable Harm, Masquerading as Social Policy Reforms

Updated: Aug 2, 2021

Mo Stewart

Independent Disability Studies Researcher


Adopting Thatcher’s “dark legacy”


As the world is preoccupied by the pandemic, and the public are beginning to comprehend the full impact of Brexit, the growing mental health crisis created by the welfare reforms has been totally disregarded. Few people realised that preventable harm was the inevitable creation of successive social policy reforms, gradually adopted by every administration since Thatcher, on route to her political ambition which is the demolition of the welfare state to be replaced by private healthcare insurance. In order to demolish the welfare state, it was first necessary to remove the past psychological security provided by the welfare state. This has been achieved. In 2010 the Coalition administration vehemently challenged the integrity of the chronically ill and disabled community who claimed disability benefits. They watched as their rhetoric encouraged a 213 per cent increase in disability hate crimes, and they disregarded the many thousands of deaths linked to the work capability assessment; which was adopted by the Department for Work and Pensions to restrict access to long-term disability benefit. Influenced by corporate America since 1992, the social policy reforms guaranteed that many of those in greatest need were destined to die when killed by the State.


Detailed evidence in the Preventable Harm Project (the Project), that I led for ten years until December 2019, identified that a public mental health crisis within the disabled community was inevitable for disability benefit claimants, when considering successive social policy reforms of the past forty years; which exacerbated the recently identified mental health problems linked with the distress of the Covid-19 pandemic (Marshall et al, 2020). The adoption of neoliberal politics by the Thatcher administration(s) (1979-1990) demanded that “Cash Not Care” (Stewart, 2016) became the only political priority for social policy funding. Human suffering was inevitable, and is demonstrated by the Project as being increased by the most recent social policy reforms, adopted since 2010, using an ongoing fiscal priority when disregarding health and wellbeing (Barr et al, 2016a; Dwyer, 2018; 2019; Stewart, 2019a).


Predominantly used in healthcare, the most common definition of the terminology of “preventable harm” was identified in 2012 as meaning the “presence of an identifiable, modifiable cause of harm” (Nabhan et al, 2012). Given the identified negative human consequences of social policy reforms adopted by every administration since Thatcher, it seems likely that the healthcare professions were very soon alerted to the preventable harm created by the adoption of neoliberal politics negatively impacting on those in greatest need.


For social scientists, whose peer-reviewed published research papers exposed the relentless suffering created by increasingly extreme and authoritarian social policy reforms in the United Kingdom (UK), there are few who identify today’s suffering of those in greatest need with the political decisions and social policies of the distant past (Stewart, 2017; 2018a; 2019b). In reality it was Margaret Thatcher (1925-2013), in a 1982 Cabinet meeting, who announced her ultimate political ambition as being the removal of the UK welfare state, to be eventually replaced by private health insurance; in keeping with the welfare programme in the United States (US) (Travis, 2012; 2016). Every administration since Thatcher has worked towards that political ambition, which enjoys bipartisan support, regardless of the preventable harm it was always destined to create (Stewart, 2019c; 2019d; 2019e; 2020a).


There is no such thing as society” is one of the most popular of all Margaret Thatcher quotes, taken from a very famous interview in the Woman’s Own Magazine (Keay, 1987). The interview was conducted in 1987 during what was Thatcher’s third term in office as the UK Prime Minister (PM). Her devotion to individualism, as opposed to society, and her strong belief in a small state, financial deregulation, and free-market trade became popularly known as “Thatcherism” (BBC, 2013; Scott-Samuel et al, 2014). This neoliberal ideology negatively impacted across society, and Thatcher’s influential “dark legacy” was identified by Guardian columnist and Thatcher biographer, Hugo Young (2013):

“Much of any leader’s record is unremarkable dross, and Thatcher was no exception. But keeping the show on the road is what all of them must first attend to, because there’s nobody else to do it. Under this heading, Thatcher left a dark legacy that, like her successes, has still not disappeared behind the historical horizon. Three aspects of it never leaves my head.


The first is what changed in the temper of Britain and the British. What happened at the hands of this woman’s indifference to sentiment and good sense in the early 1980s brought unnecessary calamity to the lives of several million people who lost their jobs. It led to riots that nobody needed. More insidiously, it fathered a mood of tolerated harshness. Materialistic individualism was blessed as a virtue, the driver of national success. Everything was justified as long as it made money - and this, too, is still with us.


Thatcherism failed to destroy the welfare state. The lady was too shrewd to try that, and barely succeeded in reducing the share of the national income taken by the public sector. But the sense of community evaporated. There turned out to be no such thing as society, at least in the sense we used to understand it. Whether pushing each other off the road, barging past social rivals, beating up soccer fans, or idolising wealth as the only measure of virtue, Brits became more unpleasant to be with. This regrettable transformation was blessed by a leader who probably did not know it was happening because she didn’t care if it happened or not. But it did, and the consequences seem impossible to reverse...”

Neoliberal politics


Thatcher’s fundamental belief in neoliberal politics, and the private market, dominated all public sector reform(s), and has been continued by every successive UK administration as “the legacy of Thatcherism in this major sphere of public policy has endured, and continues to this day” (Dorey, 2015). Under Thatcher’s leadership, the UK was gradually transformed from a welfare state into a neoliberal state, with no consideration of the negative human consequences which were inevitable following major social policy reforms; which gradually swept the globe (OECD, 2003). Thatcher’s social policies were designed using a fiscal priority, as corporate profit was prioritised over public need. All evidence of a moral compass disappeared under the cloak of neoliberalism. This included social housing (Dorey, 2015; Scott-Samuel et al, 2014). Thatcher’s devotion to neoliberal ideology removed access to social housing, and remains an ongoing crisis for the poor (Farrell, 2015), as justified when “Thatcher’s government insisted that it could no longer be a universal provider” (Kavanagh, 2011); which was destined to negatively impact on public mental health (Shelter, 2017).


Many believed that Thatcher’s insistence that the UK welfare state should be removed, and replaced by private healthcare insurance (Gamble, 1988; Travis 2012; 2016), was influenced by her well documented informal transatlantic alliance with the US President Ronald Reagan, from 1981 to 1989. Reagan was the US President during most of Thatcher’s time in office as PM, and was identified as being Thatcher’s “political soulmate” as “both worked to dismantle government bureaucracies and deregulate key industries” (Leinwand Leger D, 2013).

Figure 1: Thatcher’s close bond with Reagan ©Crippencartoons, 2021


Influenced by her devotion to neoliberal ideology, Thatcher’s insistence that the UK welfare state was an unacceptable financial burden to the public purse guaranteed that every successive neoliberal administration continued to restrict public spending. Despite political rhetoric regarding the burden of the costs of the UK welfare state, since Thatcher, the UK allocated a much smaller percentage of gross domestic product (GDP) on public spending when compared with other European nations (Dorling, 2021).


The adoption of preventable harm


Thatcher stepped down as PM in November 1990, in a dramatic resignation following a challenge to her leadership (White, 2013). She was succeeded as the UK PM (1990-1997) by the Conservative Member of Parliament (MP) John Major, whose domestic agenda was to continue with Thatcher’s social policy ambition by inviting corporate America to influence future UK social policy reforms (Rutherford, 2007; Stewart, 2016; 2018a).


As the PM, John Major consulted UnumProvident Insurance from 1992 and appointed John LoCascio, the Vice-President of UnumProvident Insurance, as the official UK government adviser on welfare claims management from 1994. By 1995, LoCascio co-authored an academic paper with the government’s chief medical adviser, Mansel Aylward (Aylward and LoCascio, 1995), which advised that family doctors (GPs) should not be involved with the assessment of patients in need of disability benefit. The authors recommended the use of a non-medical biopsychosocial (BPS) functional assessment model, which disregards all clinical opinion (Stewart, 2018b). To restrict UK disability benefit claims Incapacity Benefit (IB) was introduced in 1997 by the Major administration with the adoption of the new All Work Test, using the recommended non-medical BPS model conducted by government doctors (Rutherford, 2007) as identified by the Centre for Welfare Reform (Stewart, 2020a):

“This abandonment of the clinical opinion of GPs was achieved when Incapacity Benefit (IB) replaced Invalidity Benefit as the long-term out-of-work disability benefit (Wikeley, 1995). The new All Work Test was introduced in 1997 for the assessment of IB claimants, which was identified as highlighting the division between the “deserving” and “undeserving” poor (Wikeley, 1995). This All Work Test adopted the non-medical BPS functional assessment model, as designed by Aylward and LoCascio (1995), which followed the design of the non-medical functional assessment model adopted by UnumProvident Insurance (Stewart 2020a:5).”

UnumProvident Insurance were identified in 2005 by the California Department of Insurance Commissioner as being an “outlaw company” and a company that “has operated in an illegal fashion for years” (Mundy, 2011), and they were identified in 2008 by the American Association of Justice as being “the second worst insurance company in America” (AAJ, 2008: 6). Yet, this notorious American corporate giant influenced and funded DWP commissioned social policy research (Aylward and LoCascio, 1995; Waddell and Aylward, 2005; 2010; Waddell and Burton, 2006); which guaranteed the adoption of preventable harm for anyone who was unfit to work when the research recommendations were included in future social policy legislation (DWP, 2006; DWP, 2008; DWP, 2010; DWP, 2016.) UnumProvident Insurance successfully used a flawed non-medical BPS functional assessment model to limit access to health insurance claims in the US (Langbein, 2007), and they guided successive administration(s) as to how to adopt a similar non-medical BPS assessment model to restrict future disability benefit claims in the UK (Stewart, 2018a).


Following the general election in May 1997, Tony Blair was appointed as the new UK PM (1997-2007) following a landslide victory for “New Labour”, which was the name adopted to distance the party from the socialist leanings of previous Labour governments. Blair moved the party to the centre, which effectively meant moving it to the right, and continued with the neoliberal social policy agenda introduced by the previous Thatcher and Major Conservative administrations. Social policy reforms, commonly known as “welfare reforms,” were at the top of Blair’s domestic agenda, and Blair quickly introduced social and labour market policies from the US as the “reforms involve a radical paradigm shift since they are based on a typical American “workfare” approach” (Daguerre, 2004). This was the continuation of American influence with UK social policies.


In keeping with the Thatcher and Major Conservative administrations, Blair continued with the restriction of UK public spending, as demonstrated in the comparison of public spending in 14 European countries between 1980 - 2026, where the UK is identified as spending the least percentage of GDP over the past forty years (Dorling, 2021).